Boeun Lee, Presenter: Nothing to Disclose

Eun-Suk Cha MD, Abstract Co-Author: Nothing to Disclose

Jin Chung MD, Abstract Co-Author: Nothing to Disclose

Jee Eun Lee MD, Abstract Co-Author: Nothing to Disclose

Jeoung Hyun Kim, Abstract Co-Author: Nothing to Disclose

To evaluate the diagnostic performance and usefulness of SWE for differential diagnosis of complex cystic breast lesions, in comparison with conventional ultrasound (US).

From January 2013 to November 2013, of 140 women who had been performed conventional US and SWE, 140 complex cystic breast lesions were included in this study. All patients underwent US-guided core biopsy or surgical excision. BI-RADS US final assessment and SWE parameters (qualitative maximum elasticity using a six-level visual color scale, homogeneity of elasticity, color pattern) were recorded for each lesion. Final assessment of SWE with US was based on BI-RADS US lexicon, however, the final assessment was downgraded for dark blue and light blue lesions and upgraded for orange and red lesions. Sensitivity and specificity were calculated, while category 4b, 4c or 5 indicated malignancy and category 3 or 4a was regarded as a benign interpretation. Histopathologic diagnosis was used as reference standard.

Of the 140 complex cystic lesions, 30 lesions (21.4%) were malignant. Large size (22.7mm vs. 14.8mm), old age (52.7 years vs. 43.6 years), symptomatic lesions (70% vs. 31.8%) and final assessments for US and SWE with US were significant with malignancy (P<0.05). Of group of 30~70% cystic portion, malignancy rate was significant as 37.8%. Mean maximum elasticity of malignant lesions (187.75kPA) was significantly higher than that of benign (46kPa) (P<0.001). Homogeneity of elasticity and color pattern were significantly different from malignancy and benign lesions (P<0.05). Sensitivity of US and SWE with US were 33.3% and 93.3% (P< 0.001, Kappa =0.069) and specificity of US and SWE with US were 94.5% and 96.4% (P=0.687, kappa=0.373). Diagnostic accuracy was improved after adding SWE (21.4% to 86.4%). Using SWE with US, we could reduce benign biopsy rate from 100% to 16.4% (18/110) and 74.4 % (93/125) of category 4a lesions were downgraded to category 3.

For complex cystic breast lesions, SWE is able to increase in the accuracy and sensitivity in distinguishing benign from malignant lesions and to avoid unnecessary benign biopsy.

The combination of US and SWE is useful in differential diagnosis of complex cystic breast lesions with reducing benign biopsy rate.

Lee, B, Cha, E, Chung, J, Lee, J, Kim, J, Diagnostic Performance of Shear-wave Elastography (SWE) in Complex Cystic Breast Lesions in Comparison with Conventional Ultrasound.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14007624.html